1
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Autologous stem cell transplantation as bridging therapy followed by CD19 CAR-T cells in relapsed-refractory large B cell lymphoma. Bone Marrow Transplant 2022; 57:837-839. [PMID: 35260803 DOI: 10.1038/s41409-022-01632-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/08/2022]
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2
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Watanabe M, Kanda J, Arai Y, Hishizawa M, Nishikori M, Ishikawa T, Imada K, Ueda Y, Akasaka T, Yonezawa A, Nohgawa M, Kitano T, Itoh M, Takeoka T, Moriguchi T, Yago K, Arima N, Anzai N, Watanabe M, Kondo T, Takaori-Kondo A. Impact of Donor Source on Allogeneic Hematopoietic Stem Cell Transplantation for Mature T Cell and Natural Killer Cell Neoplasms in the Kyoto Stem Cell Transplantation Group. Biol Blood Marrow Transplant 2020; 26:2346-2358. [DOI: 10.1016/j.bbmt.2020.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/18/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022]
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3
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Bento L, Boumendil A, Finel H, Khvedelidze I, Blaise D, Fegueux N, Castagna L, Forcade E, Chevallier P, Mordini N, Brice P, Deconinck E, Gramatzki M, Corradini P, Hunault M, Musso M, Tsoulkani A, Caballero D, Nati S, Montoto S, Sureda A. Tandem autologous-reduced intensity allogeneic stem cell transplantation in high-risk relapsed Hodgkin lymphoma: a retrospective study of the Lymphoma Working Party-EBMT. Bone Marrow Transplant 2020; 56:655-663. [PMID: 33046830 DOI: 10.1038/s41409-020-01075-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 11/09/2022]
Abstract
Autologous hematopoietic stem cell transplantation (ASCT) is curative for a proportion of patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL). However, there is a small group of patients with high-risk of relapse after ASCT that might benefit from other approaches. We conducted a retrospective analysis on 126 patients treated with tandem ASCT-reduced intensity conditioning (RIC)-allogeneic-SCT and reported to the EBMT registry to analyze the efficacy and safety of this approach. Patients were included if they had received an ASCT followed by a planned RIC-SCT in <6 months without relapse between the procedures. The median time between diagnosis and ASCT was 16 months (2-174). The median number of lines prior to ASCT was two (33% of the patients received >3 lines). Forty-one percent were transplanted with active disease. The median follow-up was 44 months (6-130). Three-year-progression-free survival (PFS), overall survival (OS), incidence of relapse (IR), and non-relapse mortality (NRM) after the tandem were 53% (45-64), 73% (65-81), 34% (24-42), and 13% (8-21), respectively. This is the largest series analyzing the efficacy and safety of a tandem approach in R/R HL. The low NRM and IR with promising PFS and OS suggest that this might be an effective procedure for a high-risk population.
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Affiliation(s)
- Leyre Bento
- Hematology Department, Son Espases University Hospital, IdISBa, Palma de Mallorca, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sandro Nati
- Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Silvia Montoto
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anna Sureda
- Institut Català d'Oncologia (ICO)-Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain
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4
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Gardenswartz A, Cairo MS. Hematopoietic Progenitor Cell Transplantation in Children, Adolescents, and Young Adults With Relapsed Mature B-Cell NHL. J Natl Compr Canc Netw 2020; 18:1135-1142. [PMID: 32755988 DOI: 10.6004/jnccn.2020.7617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
Although children, adolescents, and young adults with newly diagnosed B-cell non-Hodgkin's lymphoma enjoy excellent overall survival with current chemoimmunotherapy, those with relapsed and/or refractory disease have a dismal prognosis. Although most clinicians would agree that hematopoietic progenitor cell transplantation after reinduction therapy is frontline therapy for these patients, there is no consensus as to what type of hematopoietic progenitor cell transplantation promises the best event-free and overall survival. This review outlines the disparate types of stem cell therapy that have been used in this difficult-to-treat population as well as the role of maintenance and CAR T-cell therapy in conjunction with stem cell therapy.
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Affiliation(s)
| | - Mitchell S Cairo
- Departments of Pediatrics.,Pathology.,Medicine.,Microbiology and Immunology, and.,Cell Biology and Anatomy, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, New York
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5
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Gauthier J, Chantepie S, Bouabdallah K, Jost E, Nguyen S, Gac AC, Damaj G, Duléry R, Michallet M, Delage J, Lewalle P, Morschhauser F, Salles G, Yakoub-Agha I, Cornillon J. [Allogeneic haematopoietic cell transplantation for diffuse large B cell lymphoma: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2017; 104:S131-S135. [PMID: 29173980 DOI: 10.1016/j.bulcan.2017.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/16/2017] [Accepted: 10/22/2017] [Indexed: 11/15/2022]
Abstract
Despite great improvements in the outcome of patients with lymphoma, some may still relapse or present with primary refractory disease. In these situations, allogeneic hematopoietic cell transplantation is a potentially curative option, this is true particularly in the case of after autologous stem cell transplantation if remission can be achieved. Recently, novel agents such as anti-PD1 and BTK inhibitors have started to challenge the use of allogeneic hematopoietic cell transplantation for relapsed or refractory lymphoma. During the 2016 annual workshop of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC), we performed a comprehensive review of the literature published in the last 10 years and established guidelines to clarify the indications and transplant modalities in this setting. This section specifically reports on our conclusions regarding diffuse large B cell lymphoma.
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Affiliation(s)
- Jordan Gauthier
- CHRU Lille, pôle spécialités médicales et gérontologie, secteur allogreffe de cellules souches hématopoïétiques, service des maladies du sang, 59037, Lille, France; UFR médecine, université de Lille, 59000 Lille, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Sylvain Chantepie
- AP-HP, hôpital La-Pitié-Salpêtrière, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Krimo Bouabdallah
- CHU Caen, service d'hématologie, Caen, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Edgar Jost
- AP-HP, hôpital Saint-Antoine, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Stéphanie Nguyen
- CHU Haut-Lévêque, service d'hématologie, Bordeaux, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Anne-Claire Gac
- AP-HP, hôpital La-Pitié-Salpêtrière, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Gandhi Damaj
- AP-HP, hôpital La-Pitié-Salpêtrière, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Rémy Duléry
- AP-HP, hôpital Saint-Antoine, service d'hématologie, Paris, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Mauricette Michallet
- CHU Lyon, service d'hématologie, Lyon, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Jérémy Delage
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne; CHU de Montpellier, service d'hématologie, Montpellier, France
| | - Philippe Lewalle
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne; Institut Jules-Bordet, université Libre-de-Bruxelles, service d'hématologie, Bruxelles, Belgique
| | - Franck Morschhauser
- CHRU Lille, pôle spécialités médicales et gérontologie, secteur allogreffe de cellules souches hématopoïétiques, service des maladies du sang, 59037, Lille, France; UFR médecine, université de Lille, 59000 Lille, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Gilles Salles
- CHU Lyon, service d'hématologie, Lyon, France; Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne
| | - Ibrahim Yakoub-Agha
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne; CHU de Lille, LIRIC Inserm U995, université de Lille-2, 59000 Lille, France
| | - Jérôme Cornillon
- Universitätsklinikum Aachen, Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Aachen, Allemagne; Institut de cancérologie Lucien-Neuwirth, département d'hématologie clinique, Saint-Priest-en-Jarez, France.
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6
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Crocchiolo R, Castagna L, Garciaz S, Fürst S, El Cheikh J, Sarina B, Bramanti S, Granata A, Vai A, Harbi S, Morabito L, Mohty B, Giordano L, Devillier R, Coso D, Balzarotti M, Chabannon C, Carlo-Stella C, Santoro A, Bouabdallah R, Blaise D. Tandem autologous-allogeneic stem cell transplantation as a feasible and effective procedure in high-risk lymphoma patients. Haematologica 2015. [PMID: 26206800 DOI: 10.3324/haematol.2015.129452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Luca Castagna
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Sylvain Garciaz
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Sabine Fürst
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Jean El Cheikh
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Barbara Sarina
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Stefania Bramanti
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Angela Granata
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Andrea Vai
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Samia Harbi
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Lucio Morabito
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Bilal Mohty
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Laura Giordano
- Biostatistic Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - Diane Coso
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Monica Balzarotti
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | | | - Armando Santoro
- Hematology Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Reda Bouabdallah
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Didier Blaise
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
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7
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Chen YB, Li S, Fisher DC, Driscoll J, Del Rio C, Abramson J, Armand P, Barnes J, Brown J, Cutler C, El-Jawahri A, Ho VT, Hochberg E, McAfee S, Takvorian R, Spitzer TR, Antin JH, Soiffer R, Jacobsen E. Phase II Trial of Tandem High-Dose Chemotherapy with Autologous Stem Cell Transplantation Followed by Reduced-Intensity Allogeneic Stem Cell Transplantation for Patients with High-Risk Lymphoma. Biol Blood Marrow Transplant 2015; 21:1583-8. [PMID: 26009261 DOI: 10.1016/j.bbmt.2015.05.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 05/19/2015] [Indexed: 11/19/2022]
Abstract
Many patients with lymphoma relapse after autologous stem cell transplantation (AutoSCT). These patients are often considered for allogeneic stem cell transplantation (AlloSCT) if remission can be achieved. If a tandem approach was organized, some cases of relapse might be prevented. We conducted a phase II trial of tandem AutoSCT followed by reduced-intensity conditioning (RIC) AlloSCT for patients with high-risk lymphoma. High-dose chemotherapy was given with busulfan, cyclophosphamide, and etoposide. AlloSCT was composed of RIC with busulfan/fludarabine and tacrolimus, sirolimus, and methotrexate as graft-versus-host disease (GVHD) prophylaxis. Donors were fully matched related or unrelated donors. AlloSCT was performed any time between 40 days and 6 months after AutoSCT. Forty-two patients were enrolled, and all patients underwent AutoSCT. RIC AlloSCT was performed in 29 patients. In the 29 patients who underwent tandem transplant, median time from AutoSCT to AlloSCT was 96 days (range, 48 to 169). The 6-month cumulative incidence of grades II to IV acute GVHD was 13.8% (90% confidence interval [CI], 5.3% to 26.3%). Cumulative incidence of chronic GVHD at 1 year was 37.9% (90% CI, 23.1% to 52.7%). Nonrelapse mortality at 2 years after AlloSCT was 11.1% (90% CI, 3.5% to 23.6%). At a median follow-up of 30 months (range, 17.1 to 51.5) for the entire group, the 2-year progression-free survival rate was 64% (90% CI, 50% to 75%) and the 2-year overall survival rate was 69% (90% CI, 43% to 85%). For the 29 patients who underwent tandem SCT, the 2-year progression-free survival rate was 72% (90% CI, 55% to 83%) and the 2-year OS rate was 89% (90% CI, 74% to 96%). Tandem AutoSCT-RIC AlloSCT appears to be safe and effective in patients with high-risk lymphoma. Prospective trials using such an approach in specific lymphoma subtypes are warranted.
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Affiliation(s)
- Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Shuli Li
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David C Fisher
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jessica Driscoll
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Candice Del Rio
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeremy Abramson
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Philippe Armand
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jeffrey Barnes
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer Brown
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Corey Cutler
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Areej El-Jawahri
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Vincent T Ho
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ephraim Hochberg
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven McAfee
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ronald Takvorian
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Thomas R Spitzer
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph H Antin
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert Soiffer
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eric Jacobsen
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
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8
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Castagna L, Crocchiolo R, Giordano L, Bramanti S, Carlo-Stella C, Sarina B, Chiti A, Mauro E, Gandolfi S, Todisco E, Balzarotti M, Anastasia A, Magagnoli M, Brusamolino E, Santoro A. High-dose melphalan with autologous stem cell support in refractory Hodgkin lymphoma patients as a bridge to second transplant. Bone Marrow Transplant 2015; 50:499-504. [PMID: 25621797 DOI: 10.1038/bmt.2014.304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 10/27/2014] [Accepted: 10/31/2014] [Indexed: 11/09/2022]
Abstract
Persistence of disease after salvage therapy among relapsed or refractory Hodgkin lymphoma (HL) patients predicts poor outcome. Here, we report on 41 HL patients with active disease after salvage therapy and who received high-dose melphalan (HD-PAM) and auto-SCT as a bridge to a second autologous or an allogeneic transplantation between 2002 and 2013 at our center. Disease response was based on 18-fluoro-deoxyglucose-positron emission tomography results in all patients. Overall response rate after HD-PAM was 78% and it did not differ among PR or stable/progressive disease patients (P=1.00). Response was associated with better OS: hazard ratio=0.32 (95% confidence interval: 0.13-0.77, P=0.01) irrespective of disease status before HD-PAM. Thirty-three patients (80%) were able to complete the planned treatment, intended as tandem autologous or auto-allo transplant. Hematological and extrahematological toxicity of HD-PAM was manageable, without any treatment-related death. In conclusion, HD-PAM is a valuable therapeutic option in relapsed/refractory HL patients with active disease after salvage therapy, with an impressive 78% overall response rate and 80% rate of proceeding to further transplantation. The present data may be integrated with the growing literature on new drugs in the field of relapsed/refractory HL.
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Affiliation(s)
- L Castagna
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - R Crocchiolo
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - L Giordano
- Statistic Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - S Bramanti
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - C Carlo-Stella
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - B Sarina
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - A Chiti
- Nuclear Medicine Department, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - E Mauro
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - S Gandolfi
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - E Todisco
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Balzarotti
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - A Anastasia
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Magagnoli
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - E Brusamolino
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - A Santoro
- Department of Oncology and Hematology, Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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9
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Kim SW. Hematopoietic stem cell transplantation for follicular lymphoma: optimal timing and indication. J Clin Exp Hematop 2014; 54:39-47. [PMID: 24942945 DOI: 10.3960/jslrt.54.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The definitive management of advanced follicular lymphoma (FL) remains controversial due to various treatment options, including watchful waiting, single-agent or combination chemotherapy, monoclonal antibody, and radioimmunotherapy. These options can provide prolonged progression-free survival. However, they cannot cure advanced FL. Allogeneic hematopoietic stem cell transplantation (allo-SCT) remains the sole curative therapy for FL. Allo-SCT has had a major impact with the use of reduced-intensity conditioning regimens because of its lower associated nonrelapse mortality compared with myeloablative regimens. Autologous SCT (auto-SCT) shows high response rates and extends progression-free survival in patients with chemosensitive relapse. In the rituximab era, however, associated comorbidities, risk of secondary cancers, and presence of refractory disease have become problematic in the auto-SCT population. On the basis of results from large-scale randomized trials, upfront auto-SCT is not recommended. Novel conditioning regimens including radioimmunotherapy followed by either auto-SCT or allo-SCT are likely to show efficacy even in chemorefractory disease. Consequently, the optimal timing for SCT remains a matter of opinion, except for patients in first remission. However, the outcomes of allo-SCT and auto-SCT keep on improving. Physicians should note that there is no therapy with a track record equivalent to that of SCT for relapsed or refractory FL.
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Affiliation(s)
- Sung Won Kim
- Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital
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10
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Allogeneic hematopoietic cell transplantation for indolent non-Hodgkin lymphoma: indications and outcomes. Curr Opin Hematol 2014; 20:509-14. [PMID: 24104411 DOI: 10.1097/moh.0b013e328365a151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Allogeneic hematopoietic cell transplantation (HCT) can potentially cure indolent non-Hodgkin lymphoma (NHL). However, the optimal timing and indications remain unclear. Here, we review recent published reports on the subject and summarize our approach. RECENT FINDINGS Recent prospective clinical trials of allogeneic HCT in indolent NHL are marked by substantial variation in eligibility criteria, patient populations, and transplant approach. Nonetheless, several common themes are apparent. Indolent NHL is highly susceptible to immunologic graft-versus-lymphoma effects and relapse rates after allogeneic HCT are uniformly low. Allogeneic HCT early in the disease course produces the highest overall and progression-free survival, but also increases patient exposure to potential transplant-related complications such as chronic graft-versus-host disease. In contrast, allogeneic HCT can be reserved as a 'last resort' for patients who are refractory to conventional chemotherapy, delaying their exposure to graft-versus-host disease and other transplant-associated risks. No trials have directly addressed the optimal timing of allogeneic HCT in indolent NHL nor prospectively compared different transplant approaches. SUMMARY Excellent outcomes have been reported with allogeneic HCT for indolent NHL, both early and late in the disease course. The optimal timing of allogeneic HCT is unknown and depends heavily on patient preferences.
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11
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Managing Hodgkin lymphoma relapsing after autologous hematopoietic cell transplantation: a not-so-good cancer after all! Bone Marrow Transplant 2014; 49:599-606. [PMID: 24442246 DOI: 10.1038/bmt.2013.226] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/27/2013] [Indexed: 01/02/2023]
Abstract
Hodgkin lymphoma (HL) relapsing after an autologous hematopoietic cell transplant (HCT) poses a therapeutic challenge. In this setting, salvage chemotherapy (for example, gemcitabine-based, ifosfamide-containing and others) or immunotherapy (for example, brentuximab vedotin) is essential as a bridging-cytoreduction strategy to an allogeneic HCT. Myeloablative allogeneic hematopoietic cell transplantation in relapsed HL is associated with high rates of non-relapse mortality. In carefully selected patients with chemosensitive disease, allografting following lower-intensity conditioning regimens can provide durable disease control rates of about 25-35%. Promising early results with haploidentical and umbilical cord transplantation are noteworthy and are expanding this procedure to patients for whom HLA-matched related or unrelated donors are not available. Unfortunately, a significant number of HL patients relapsing after an autologous HCT are not candidates for allografting because of the presence of resistant disease, donor unavailability or comorbidities. Brentuximab vedotin is approved for HL relapsing after a prior autograft. Rituximab and bendamustine are also active in this setting, albeit with short durations of remission. Histone deacetylase inhibitors (for example, panobinostat, mocetinostat), mTOR inhibitors (for example, everolimus) and immunomodulatory agents (lenalidomide) have shown activity in phase II trials, but currently are not approved for this indication. Second autologous HCT are rarely performed but this approach should not be considered standard practice at this time. The need for effective agents for post autograft failures of HL largely remains unmet. Continuous efforts to ensure early referral of such patients for allogeneic HCT or investigational therapies are the key to improving outcomes of this not-so-good lymphoma.
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